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Lipodystrophy: Your HIV Treatment in Pictures

  • Overview

    Certain medications used to treat HIV can
    cause lipodystrophy.

    Lipodystrophy is a condition that changes the
    way your body uses and stores fat. You may lose fat (called lipoatrophy) in
    some areas of your body—usually in the face, arms, legs, or buttocks. You may
    also accumulate fat (called hyperadiposity) in some areas, most commonly in the
    back of the neck, breasts, and abdomen.

    These changes in appearance can cause
    anxiety, but don’t worry. There are several approaches to managing the
    condition.

  • Switch Your HIV Medications

    Some HIV medications—such as protease
    inhibitors (Pls) and nucleoside reverse transcriptase inhibitors (NRTIs)—are
    known to cause lipodystrophy. If this is the case, the easiest solution is to
    switch medications. Taking a different medication can stop the progression and
    may even result in improvement.

    However, stopping your medications is a
    decision that requires careful consideration of your overall health. Don’t just
    stop taking your medications! Ask your doctor if another medication is a better
    option for you.

  • The Role of Diet and Exercise

    There is no specific diet for treatment of
    lipodystrophy. However, a healthy diet plays an important role in overall
    health and in maintaining a suitable body weight. Aim for a diet rich in
    omega-3, fruits and vegetables, and fiber.

    Avoid foods that are high in calories and carbohydrates,
    but low in nutritional value. Though they may be tempting, fad diets or rapid
    weight-loss schemes will only stress you out.

    Exercise may help your body’s ability to
    regulate insulin and burn off extra calories. Aerobic and strength-building
    exercises help to build strong muscles too.

  • Hormone Therapy

    In 2010, the U.S. Food and Drug Administration (FDA) approved
    a growth hormone releasing factor (GRF) called tesamorelin (Egrifta) for
    treatment of HIV lipodystrophy. The medication, which consists of powder and a
    diluting agent, must be stored in the refrigerator and away from light. You mix
    it together by rolling the vial in your hands for about 30 seconds. Once a day,
    you’ll have to inject it into your abdomen.

    Side effects may include redness or rash,
    swelling, or muscle and joint pain.

  • Liposuction

    Liposuction can remove fat from targeted
    areas. Your surgeon will mark your body before beginning. Either local or
    general anesthesia is required.

    After injecting a sterile solution to help
    with fat removal, your surgeon will make tiny incisions to insert a tube under
    your skin. The tube is connected to a vacuum. Your doctor will use a back and
    forth motion to suction fat from your body.

    Side effects may include swelling, bruising,
    numbness, or pain. Risks of surgery include puncture or infection. Fat deposits
    may eventually return.

  • Fat Transplant

    Fat can be transplanted from one part of your
    body to another. In a procedure similar to liposuction, fat is harvested from
    the abdomen, thighs, buttocks, or hips. It is then cleaned and filtered. Your
    surgeon will inject or implant it where needed, most commonly the face.

    Fat can also be frozen for later use. The big
    advantage is that by using your own fat, you face lower risk of allergic
    reaction or rejection.

  • Facial Filler: Poly-L-lactic Acid

    Poly-L-lactic acid (Sculptra, New-Fill) is an
    FDA-approved facial filler that is injected into the face. The procedure is
    performed by a doctor. Your doctor may stretch the skin while slowly giving the
    injection. Following the injection, patients are generally given a 20-minute
    massage at the injection site. This helps the substance to settle into place.
    Ice is used to decrease swelling.

    Side effects may include site pain or
    nodules. Risks include allergic reaction and injection site abscess or atrophy.
    It is usually necessary to repeat the procedure after a year or two.

  • Facial Filler: Calcium Hydroxylapatite

    Calcium hydroxylapatite (Radiesse, Radiance)
    is a soft-tissue filler FDA-approved for treatment of lipoatrophy in those who
    are HIV positive.

    During the procedure, your doctor will insert
    a needle into your skin and push the plunger. They’ll slowly inject the
    substance in linear threads while withdrawing the needle.

    Side effects include injection site redness,
    bruising, numbness, and pain. The procedure may need to be repeated.

  • More Fillers

    There are a variety of facial fillers in use today, including:

    • polymethylmethacrylate
      (PMMA; Artecoll, Artefill)
    • bovine
      collagens (Zyderm, Zyblast)
    • human
      collagens (CosmoDerm, CosmoPlast)
    • silicone
    • hyaluronic
      acid

    These are temporary fillers, so it may be
    necessary to repeat the procedure. Not all of these methods are recommended for
    people who are HIV positive. Ask your doctor about the possible risks of these
    substances and procedures.

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References:

  • Calcium hydroxylapatite. (n.d.). Medscape
    Reference
    . Retrieved July 18, 2013 from http://reference.medscape.com/drug/radiesse-calcium-hydroxylapatite-999826
  • FDA approves Egrifta to treat Lipodystrophy in
    HIV patients. (2010, November 10). News
    release,
    U.S. Food and Drug
    Administration
    . Retrieved July 17, 2013 from http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm233516.htm
  • Lipodystrophy. (2005, October). AIDS
    info,
    U.S. Department of Health and
    Human Services.
    Retrieved July 17, 2013 from http://www.aidsinfo.nih.gov/contentfiles/lipodystrophy_fs_en.pdf
  • Lipodystropy in HIV – Treatment & Management. (2013,
    July 15). Medscape Reference.
    Retrieved July 18, 2013 from http://emedicine.medscape.com/article/1082199-overview – a11
  • Liposuction – Risks. (2013, March 14). Mayo Clinic Staff, Mayo Clinic. Retrieved
    July 18, 2013 from http://www.mayoclinic.com/health/liposuction/MY00079/DSECTION=risks
  • Liposuction – What you can expect. (2013, March 14). Mayo Clinic Staff, Mayo Clinic.
    Retrieved July 18, 2013 from http://www.mayoclinic.com/health/liposuction/MY00079/DSECTION=what-you-can-expect
  • Poly-L-lactic acid/carboxymethylcellulose/mannitol. (n.d.). Medscape Reference. Retrieved July 18,
    2013 from http://reference.medscape.com/drug/sculptra-aesthetic-poly-l-lactic-acid-carboxymethylcellulose-mannitol-999827
  • Restorative Treatment Approaches for HIV-Associated Lipodystrophy. (2005,
    September). Jeffrey S. Roth, MD, PhD, Physicians Research Network.
    Retrieved July 17, 2013 from http://www.prn.org/index.php/complications/article/restorative_treatment_hiv_associated_lipoatrophy_73
  • Shah M.
    et al. (2005, July). The role of diet, exercise and smoking in dyslipidaemia in
    HIV-infected patients with lipodystrophy. HIV
    Med. 
    2005 Jul;6(4):291-8. Retrieved July 17, 2013 from http://www.ncbi.nlm.nih.gov/pubmed/16011535?dopt=Abstract
  • Terry L. et al. (2006,
    March). Exercise training in
    HIV-1-infected individuals with dyslipidemia and lipodystrophy. Med Sci Sports Exerc 2006
    Mar;38(3):411-7. Retrieved July 17,
    2013 from http://www.ncbi.nlm.nih.gov/pubmed/16540826?dopt=Abstract
  • Tesamorelin (Rx) –
    Egrifta. (n.d.). Medscape Reference.
    Retrieved July 18, 2013 from http://reference.medscape.com/drug/egrifta-tesamorelin-999613

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